Tuesday, August 11, 2015

Music therapy has become
an integral part of many programs for children with autism. The broad category
of music therapy is generally described as interventions that seek to teach
individual skills or goals through music. Music therapists use their training
as musicians, clinicians, and researchers to effect changes in cognitive,
physical, communication, social, and emotional skills. According to the National Autistic Society, “Music therapy
aims to encourage increased self-awareness/self-other awareness, leading to
more overt social interactions. The therapy stimulates and develops the
communicative use of voice and pre-verbal dialogue with another, establishing
meaning and relationship to underpin language development. The client may also
benefit from increased tolerance of sound, tolerance of and capacity for
two-way communication.”

Research
Autism reports strong positive evidence from peer-reviewed journals that
support the effectiveness of music therapy for individuals with autism spectrum
disorders (ASD). Based on the literature to date, music therapy has shown good
effects in influencing joint attention, social interaction, verbal and gestural
communication and behavior. It is considered to be a useful intervention,
particularly with young children, and where language acquisition is either
delayed or disordered to a severe degree. Currently, music therapy
is identified as an emerging intervention by the National Autism Center (2015)
and incorporates many of the identified ASD-specific evidence-based practices.Supporters of music therapy emphasize
that it can be used to develop social engagement, joint attention, communication
abilities, while also addressing emotional needs and quality of life.

A study published in the
journal Autism
provides further support for the effectiveness of music therapy with ASD. This
study investigated the social-motivational aspects of musical interaction
between the child and the therapist in improvisational music therapy by
measuring emotional, motivational and interpersonal responsiveness in children
with autism during joint engagement episodes. Improvisational music therapy is
an individualized intervention that facilitates moment-by-moment motivational
and interpersonal responses in children with autism. Compared with other
therapeutic interventions utilizing music as a background or contingent
stimulus, improvisational music therapy involves the interactive use of live
music for engaging clients to meet their therapeutic needs. It is gaining
growing recognition as an effective intervention addressing fundamental levels
of spontaneous self-expression, emotional communication and social engagement
for individuals with a wide range of developmental disorders.

Design

This randomized controlled
exploratory study employed a single subject comparison design in two different
conditions (improvisational music therapy versus toy play sessions) and two different
parts of a session (an undirected/child-led part versus a more directed/therapist-led
part) in each condition. The objective was to compare the effects of these two
different media (music versus toys) and to determine how children respond in a musical
context with or without direction, compared with a non-musical context such as
play activities with toys with or without direction.

Participants and Procedure

Participants were children
aged between 3 and 5 who were not previously treated with either music therapy
or play therapy. A total of ten children (all male) completed the clinical
trials. Five children were non-verbal while the other five were verbal with
varying degrees of language skills. Eight children were in preschool special
education, and two were in mainstream preschool programs that included
additional therapeutic supports, such as speech language therapy. The children
were randomly assigned either to have the music therapy sessions first and the
toy play sessions later (group 1), or vice versa (group 2). In order to
differentiate the media used in these two conditions, the therapists in music
therapy were instructed to interact with the child mainly through music,
whereas the therapists in the toy play condition were instructed to engage the
child by any means, but to avoid any musical media, such as singing or rhythmic
playing.

Observed behaviors were
recorded in terms of both their frequency and their duration for two broad
categories. The first category concerned the participant’s emotional and
motivational responsiveness (joy, emotional synchronicity, initiation of
engagement) towards different types of attunement promoted by the therapist in
these two conditions. The second category concerned two different types of
responsiveness towards the therapist’s initiation of interaction (social
invitation and interpersonal demands). Joy referred to an event when the child
either smiled (facial expression duration only), or laughed (facial expression
with vocal sound) during the interaction with the therapist. Emotional
synchronicity referred to an event when the child and the therapist shared a
moment of emotional affect duration (happiness or sadness) while engaged with
each other. Initiation of engagement referred to an event where the child
spontaneously initiated interaction with the therapist, or initiated a change
during ongoing interaction, and then expected the therapist to follow.

Results and Discussion

Improvisational music
therapy produced markedly more and longer events of joy, emotional synchronicity
and initiation of engagement behaviors in the children than toy play sessions.
In response to the therapist’s interpersonal demands, ‘compliant (positive)
responses’ were observed more in music therapy than in toy play sessions, and
‘no responses’ were twice as frequent in toy play
sessions as in music therapy. In the music therapy condition, there were more joy,
emotional synchronicity and initiation of engagement events in the undirected
part than the directed part, suggesting that children were happier, more able
to express their happy emotions and more able to share their affects with the
therapist when leading. These results suggest that musical attunement enhances
musical-emotional communication together with joy and emotional synchronicity,
which results in children’s spontaneous willingness to respond, initiate and
engage further.

According to the authors,
“The temporal structure of music and the specific use of musical attunement in
improvisational music therapy suggests that we can help children with autism
experience and develop affective skills in a social context.” Creating music relates to the child’s
expression, interest and focus of attention may evoke responses from the child
to a therapist creating such relational music for them. Moreover, improvising
music together is an emotionally engaging process. Music can be an attractive
medium, allowing the child his/her own space and the choice of objects, at the
same time engaging the child with different objects of the therapist’s choice.

Of course, this
“exploratory” study has limitations.For
example, the small sample makes any generalizable conclusion premature. The
test power is low and should be considered when interpreting the results.
Likewise, the small sample limits the relevance of subgroup analyses (language,
age, severity) as well as therapists’ effects which would be helpful to
understanding how children with different developmental needs respond to this
type of intervention different therapists.

Conclusion

In conclusion, the results
of this exploratory study found significant evidence supporting the value of
music therapy in promoting social, emotional and motivational development in
children with autism. The findings highlight the importance of social-motivational
aspects of musical interaction between the child and the therapist, the
therapeutic potential of such aspects in improvisational music therapy, and the
relative value of less directed and more child centered approaches for children
with autism. The authors conclude, “Both previous and the current study
indicate that we should use music within the child’s focus of attention,
behavioral cue and interests, whether it is improvised or precomposed. A future
study should perhaps look at the differential effect on response of improvised
and precomposed music with young children with autism.”

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